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Saudi Journal of Kidney Diseases and Transplantation
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EDITORIAL Table of Contents   
Year : 2003  |  Volume : 14  |  Issue : 1  |  Page : 1-4
Impacts of Intifada on Renal Services

Shifa Hospital, Ministry of Health, Palestine

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How to cite this article:
Ali Abu Shahla FM. Impacts of Intifada on Renal Services. Saudi J Kidney Dis Transpl 2003;14:1-4

How to cite this URL:
Ali Abu Shahla FM. Impacts of Intifada on Renal Services. Saudi J Kidney Dis Transpl [serial online] 2003 [cited 2022 Aug 7];14:1-4. Available from: https://www.sjkdt.org/text.asp?2003/14/1/1/33080

   Geography and Demography Top

The Palestinian National Authority (PNA) is currently in control of two geographically separated areas: the West Bank and Gaza Strip (GS). The West Bank is divided into four geographical regions: The north, which includes the districts of Nablus, Jenin and Tulkarem; the center, which includes the districts of Rammallah and Jerusalem, and the south that includes Bethlehem and Hebron districts besides the sparsely populated Jordan Valley that includes the town of Jericho.

The West Bank, which has an area of 5800 square km, is the homeland for more than two million Palestinians. The GS is a narrow heavily populated piece of land lying on the Eastern coast of the Mediterranean Sea. It is heavily populated with total area of 360 sq. km.

The population in GS is mainly concen­trated in the cities. From the administrative point of view, the GS is divided into five Governorates: Gaza North, Gaza Mid-zone, Khan Younis and Rafah in the South.

The Healthcare Delivery System in Palestine:

In Palestine, the healthcare services are delivered at two levels: primary healthcare and secondary healthcare.

The Primary Healthcare:

There are 594 primary health centers (PHCs); 100 in GS and 495 in the West Bank. Sixty percent of the PHCs are owned and operated by the Palestinian ministry of health (MOH), 9% are owned and operated by the UNRWA. The remaining PHCs are owned and operated by NGO's.

In the West Bank, there are 4,247 indivi­duals per PHC, while in the Gaza Strip the ratio is 11,965 per PHC.

The Secondary Healthcare:

In the PNA held territories, there are 65 hospitals; 17 in GS and 48 in the West Bank.

In Palestine, there are 14 beds per 10,000 inhabitants. The Palestinian MOH owns and operates 15 hospitals with a total capacity of 2,303 beds, while the UNRWA has one hospital in the West Bank, which has a capacity of 38 beds. There are 22 hospitals owned and operated by the private sector with a total capacity of 453 beds. Twenty­five hospitals with a total capacity of 1,442 beds are owned and operated by NGO's.

National Health and Economic Indicators:

As per year 2000 Statistics, the crude birth rate in Palestine is 33.2 per 1000 inhabi­tants; 33.6 in the GS and 32.8 in the West Bank. The population growth rate is 3%, which is equal to that in Syria and Lebanon, and the life expectancy is 71.8 years.

The Gross National Product (GNP) in Palestine is highly fluctuant. The GNP per capita has decreased from 1938.6 US $ in 1988 to about 1771.5 in the year 2000. The same fluctuation affected the Gross Domestic Product (GDP) per capita, which changed from 4450.8 US $ in 1998 to 4218.3 US $ in the year 2000.

The Renal Services in Palestine

The Problem: The Morbidity of the Condition:

Renal failure is one of the most important problems on the healthcare delivery system in Palestine. As per the year 2000 and 2001 statistics, there were 351 and 400 patients, respectively, who were maintained on hemodialysis and peritoneal dialysis.

The most common causes for end-stage renal failure in Palestine is glomerulo­nephritis and diabetic nephropathies.

The death rate among patients on dialysis is 7-8%; the cardiac and cerebrovascular complications are the main causes of death.

The MOH Investment in Hemodialysis Services:

The hemodialysis services in Palestine were initiated in 1972 and are recently available in nine centers. Two of those centers provide care for pediatric patients.

The Palestinian MOH owns and operates eight out of the nine centers with one specialized in pediatric hemodialysis.

In the hemodialysis centers, there are 69 hemodialysis machines, manned by 18 qualified nephrologists and 58 nursing staff.

As per the statistics for year 2000, the hemodialysis centers in Palestine performed 37,870 dialysis sessions and 1,572 peritoneal dialysis sessions. In the same year, the bed occupancy rate for hemodialysis treatment was more than 200% and for peritoneal dialysis was 53.8%. Renal transplantation was also active and the number of trans­plants performed until December 2001 was 420 from live donors.

The Impact of the Current Political Situation on the PNA Territories:

The current political situation in the Palestinian territories, which includes the Israeli military occupation since 1967, the settlements on the confiscated Palestinian lands and the continuous unprecedented aggre­ssion on the Palestinian territories since September 28, 2000, has had far reaching implications on the already vulnerable Palesti­nian society.

The continued occupation has affected all aspects of life in the Palestinian territories; healthcare delivery system, education, eco­nomy, social services programs, humanitarian services and even the holy places were not spared.

The continuous aggression on the PNA areas led to demolition of many schools, college premises and other educational institutions. The siege policies adopted by the occupation army prevented many teachers and students from reaching their schools, institutions, colleges and universities. Many people lost their lives or sustained severe injuries, handi­caps and severe social and psychological disturbances.

In the economic sector, nearly 125,000 workers previously working in the green line lost their jobs. Furthermore, almost 200,000 workers joined the long list of the unemployed in the PNA territories.

Due to repeated closure and siege policy, the industry, agriculture and construction sectors were almost ruined. Therefore, over two-thirds of the Palestinians live in poverty (less than two US $ /day).

The humanitarian and social support services for the socially vulnerable groups of the society, the handicapped, the women and children were interrupted and sometimes came to a stand still.

The healthcare delivery system was under triple effect of this situation:

  1. The tremendously increased demand for healthcare services, especially at the secondary and tertiary levels. For example, during the last quarter of the year 2000, the healthcare system was confronted with nearly 11,000 casualties including 313 fatalities. The type of injuries and the ammunition used was a real challenge for the Palestinian medical professionals in view of the little resources they had.
  2. The sharp falls in the revenues and contributions through the health insurance system that topped 50%.
  3. The direct impact of aggression on the health sector; facilities, staff and systems of work. The Israeli aggression army showed no sign of compliance with the international laws including article 16, 17 and 18 of the IV Geneva Convention. Many wounded patients were prevented from receiving any medical care. On the contrary, they were left to bleed to death. In many occasions, they were slain after being in captivity. On regular basis, the Israeli aggression forces prevented the medical personnel and equipment from reaching the areas where the needy people were waiting. In many occasions, those personnel and equipment were the targets for very intentional Israeli fire inflicting much casualty with considerable number of fatalities. The humanitarian aid vehicles were used as a cover to infiltrate the Palestinian hold territories.

In addition to those hardships, the Palestinian MOH had to fulfill its regular commitments to the local society: the environmental health program, the vac­cination program, the infectious disease control activities, primary healthcare system, and the school health and the mental health programs.

The impact of the healthcare services for renal patients:

This issue can be handled in view of the special feature for both the renal patients and the care they need.

The nature of renal failure, whether it is acute, chronic or end-stage, imposes distinctive requirements. The different modalities of renal replacement therapy require well-equipped and properly staffed facilities. The current political situation imposes many hardships that make this task almost impossible.

  • The almost continuous siege and imposed curfew prevented the MOH frequently from securing its needs of medical supplies, medications and spare parts. In many instances, the patients either lost their lives or developed complications related to their ailments. The renal transplant recipients suffered a lot from the shortage of anti-rejection drugs and many of them lost their precious grafts.
  • The policies of repeated closure and siege prevented, on many occasions, the health personnel from reaching their hospitals on time or at all. The same apply to the biomedical engineers and technicians whose presence is essential for the proper operation of the dialysis machines.
  • The patients themselves were not able to reach regularly their dialysis centers. On many occasions, they arrived late many hours after a journey full of bitter experience from checkpoint to another; some never arrived!
  • The MOH referral system of patients outside PNA came to a halt due to the adopted polices of siege and financial constrains. Referral is currently limited to the Naser Institution in Egypt. It is the only center that keeps accepting the referred patients despite the volatile financial capabilities of the PNA.
  • The national plan to set up a facility for kidney transplant within the premises of Al Shifa Hospital was completely aborted due to financial difficulties and conti­nuous siege and closure on the Pales­tinian territories.

   National Emergency Health Plan (NEHP): Top

To face the current situation, the Palestinian MOH has adopted a national emergency plan of eight-points:

  1. To decentralize the services,
  2. To encourage the community participation,
  3. To ensure better telecommunication between the GS and the WB,
  4. To ensure better cooperation and co­ordination among governmental, UN, NGO's and private health sectors.
  5. To upgrade the emergency medical services,
  6. Never to overlook the community-based programs like mental health services, school health program.
  7. To improve the rehabilitation services for the disabled.
  8. To expand the horizons for cooperation with the Arab and international arenas.

Through the adoption and the application of the NEHP, the Palestinian MOH managed to maintain its community-based health services, confront the huge and tremendous extra loads imposed by the current political situation and even to make few success stories.

New centers for hemodialysis were estab­lished and operated regularly in far and unreachable areas to overcome the siege. The new centers were equipped through the generous donations made by Arab and foreign countries. The reassignment of the available staff helped to manage those new centers. The non-governmental health sector proved to be very committed and helped in tackling the extra load imposed on the governmental sector.

Correspondence Address:
Faisal M Ali Abu Shahla
Consultant Nephrologist and Internist, Director General of Hospitals, MOH, Shifa Hospital, 26 Mustafa Hafiz Street, Palestine

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Source of Support: None, Conflict of Interest: None

PMID: 17657082

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